Immunomodulation therapy for feline leukemia virus infection

Therapeutic and Prophylactic Use of Oral, Low-Dose IFNs in Species of Veterinary Interest: Back to the Future

Cytokines are important molecules that orchestrate the immune response. Given their role, cytokines have been explored as drugs in immunotherapy in the fight against different pathological conditions such as bacterial and viral infections, autoimmune diseases, transplantation and cancer. One of the problems related to their administration consists in the definition of the correct dose to avoid severe side effects. In the 70s and 80s different studies demonstrated the efficacy of cytokines in veterinary medicine, but soon the investigations were abandoned in favor of more profitable drugs such as antibiotics. Recently, the World Health Organization has deeply discouraged the use of antibiotics in order to reduce the spread of multi-drug resistant microorganisms. In this respect, the use of cytokines to prevent or ameliorate infectious diseases has been highlighted, and several studies show the potential of their use in therapy and prophylaxis also in the veterinary field. In this review we aim to review the principles of cytokine treatments, mainly IFNs, and to update the experiences encountered in animals.

Interferon therapies in small animals

Interferons (IFNs) are cytokines that play an important role in the immune response of animals and humans. A number of studies reviewed here have evaluated the use of human, canine and feline IFNs as treatments for infectious, inflammatory and neoplastic disease in dogs and cats. Recombinant canine IFN-γ is deemed an efficacious therapy for canine atopic dermatitis. Recombinant feline IFN-ω is effective against canine parvoviral enteritis and has also been recommended for canine atopic dermatitis. Based on limited evidence, recombinant canine IFN-α could be a topical treatment option for dogs with gingivitis and keratoconjunctivitis sicca. Conclusive evidence is lacking for other diseases and large randomised controlled trials are needed before IFNs can be recommended for other indications.

Feline leukaemia virus infection: A practical approach to diagnosis

PRACTICAL RELEVANCE

Feline leukaemia virus (FeLV) is a retrovirus of domestic cats worldwide. Cats lacking strong FeLV-specific immunity and undergoing progressive infection commonly develop fatal FeLV-associated disease. Many aspects of FeLV infection pathogenesis have been elucidated, some during more recent years using molecular techniques. It is recommended that the FeLV status of every cat is known, since FeLV infection can influence the prognosis and clinical management of every sick cat. Moreover, knowledge of a cat's FeLV status is of epidemiological importance to prevent further spread of the infection.

CLINICAL CHALLENGES

Diagnosing FeLV infection remains challenging due to different outcomes of infection, which can vary over time depending on the balance between the virus and the host's immune system. Furthermore, testing for FeLV infection has become more refined over the years and now includes diagnostic assays for different viral and immunological parameters. Knowledge of FeLV infection pathogenesis, as well as the particulars of FeLV detection methods, is an important prerequisite for correct interpretation of any test results and accurate determination of a cat's FeLV status.

AIMS

The current review presents recent knowledge on FeLV pathogenesis, key features to be determined in FeLV infection, and frequently used FeLV detection methods, and their characteristics and interpretation. An algorithm for the diagnosis of FeLV infection in a single cat, developed by the European Advisory Board on Cat Diseases, is included, and FeLV testing in specific situations is addressed. As well as increasing awareness of this deadly infection in domestic cats, the aim is to contribute diagnostic expertise to allow veterinarians in practice to improve their recognition, and further reduce the prevalence, of FeLV infection.

Clinical and Hematological Follow-Up of Long-Term Oral Therapy with Type-I Interferon in Cats Naturally Infected with Feline Leukemia Virus or Feline Immunodeficiency Virus

Simple Summary

The viruses which produce feline leukemia (FeLV) and feline immunodeficiency (FIV) attack cells involved in the immune response. As specific drugs are either nonexistent, produce secondary effects, or are expensive, a therapeutic possibility is using nonspecific immunostimulants, such as human interferon alpha. We used this drug to treat 27 cats infected by FeLV and 31 infected by FIV. All cats were naturally infected and treatment was administered orally by their owners for four months. Participating cats were evaluated in our clinics at mid-treatment (M2), end of treatment (M4), and 4–8 months after the end of treatment (M10). We observed that treatment was well tolerated by the cats (as it did not affect the liver or the kidney functions), and improved most of the parameters analyzed (clinic, anemia, white cell counts, and CD4+/CD8+ ratio) as long as it was administered. However, 4–8 months after it was discontinued, though most animals remained clinically healthy, many of these parameters had rebounded to initial values or values even worse than the initial values. Thus, more studies should be conducted with longer administration of this drug to evaluate tolerability and sustained improvement of diseases produced by these two viruses which may lead to death.

Abstract

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV), two of the most important pathogens of cats, produce chronic systemic diseases with progressive death of cells involved in the immune response, ultimately leading to death. Immunostimulants is one of the few alternatives to the symptomatic treatment. In this study, 27 naturally FeLV-infected (FeLV+) and 31 naturally FIV-infected (FIV+) cats were administered orally by their owners 60 IU/day of recombinant human interferon alpha (rHuIFN-α) for four months in alternate weeks. Clinical status was evaluated and blood samples collected at four different visits or months (M): pretreatment (M0), mid-treatment (M2), end of treatment (M4), and 4–8 months after end of treatment (M10). Most cats ostensibly improved their clinical status, and many became asymptomatic. rHuIFN-α treatment improved the anemic processes observed at M0 (at least in cats with mild or moderate anemia) and leukocyte counts, including a more favorable CD4+/CD8+ ratio. An increase in the serum gammaglobulin concentration was seen in 80% of the cats. Despite observing an obvious favorable progress in the clinical, biopathological, and CD4+/CD8+ values during treatment, almost invariably all the parameters analyzed worsened after treatment discontinuation (M10), which suggests that the interferon-α protocol should be either extended or include additional cycles for a long-lasting benefit in FeLV+ and FIV+ cats.

Efficacy of antiviral chemotherapy for retrovirus-infected cats: What does the current literature tell us?

GLOBAL IMPORTANCE

The two feline retroviruses, feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV), are global and widespread, but differ in their potential to cause disease.

VIRAL INFECTION - FIV

FIV, a lentivirus that shares many properties with human immunodeficiency virus (HIV), can cause an acquired immune deficiency syndrome, which predisposes cats to other infections, stomatitis, neurological disorders and tumours. Although secondary infections are common, specific opportunistic infections or acquired immunodeficiency virus-defining infections, such as those that occur with HIV, are not commonly reported in FIV-infected cats. In most naturally infected cats, FIV does not cause a severe clinical syndrome; with appropriate care, FIV-infected cats can live many years before succumbing to conditions unrelated to their FIV infection. Thus, overall survival time is not necessarily shorter than in uninfected cats, and quality of life is usually high over many years or lifelong.

VIRAL INFECTION - FELV

FeLV, an oncornavirus, is more pathogenic than FIV. Historically, it was considered to account for more disease-related deaths and clinical syndromes in cats than any other infectious agent. Recently, the prevalence and importance of FeLV have been decreasing, mainly because of testing and eradication programmes and the use of FeLV vaccines. Progressive FeLV infection can cause tumours, bone marrow suppression and immunosuppression, as well as neurological and other disorders, and leads to a decrease in life expectancy. However, with appropriate care, many FeLV-infected cats can also live several years with a good quality of life.

PRACTICAL RELEVANCE

A decision regarding treatment or euthanasia should never be based solely on the presence or absence of a retrovirus infection. Antiviral chemotherapy is of increasing interest in veterinary medicine, but is still not used commonly.

EVIDENCE BASE

This article reviews the current literature on antiviral chemotherapy in retrovirus-infected cats, focusing on drugs that are currently available on the market and, thus, could potentially be used in cats.

Use of recombinant interferon omega in feline retrovirosis: from theory to practice

Type-I interferons (IFNs) are cytokines that have non-specific antiviral activity, participating mostly in innate defense mechanisms. Their administration has been proposed to treat several viral and immunomediated diseases as an immunomodulatory therapy. Due to its availability, recombinant human interferon-alpha (rHuIFN-α) has been studied in relation to feline retrovirosis, both in vitro and in vivo. However, IFNs are species-specific and antibodies have been shown to develop in response to the high rHuIFN-α doses necessary for an effective therapy. A recombinant feline IFN has been developed, which has been characterized as interferon-omega (rFeIFN-ω), designed to overcome these problems. Nonetheless, very few studies have been undertaken to evaluate its efficacy in cats naturally infected with FIV or FeLV. In an initial study, we here demonstrated that rFeIFN-ω can dramatically improve the clinical condition of infected cats, and induce improvement of hematologic parameters. Minor changes or no change was observed for hypergammaglobulinemia, CD4/CD8 ratio, proviral load, viremia and RT activity, suggesting that the overall effect of IFN was on innate immunity. More studies are needed in order to better understand its in vivo mechanisms.

Effect of Low-Dose Human Interferon-alpha on Shipping Fever of Thoroughbred Racehorses

To assess the effect of human interferon-alpha (IFNα) on shipping fever of Thoroughbred racehorses subjected to long-distance transportation, an IFNα preparation was orally administered to 48 horses three times (once daily, 3 successive days) before transportation (IFNα group). In the control group (25 horses), maltose was administered in the same way. These treatments induced no abnormal findings in Thoroughbred racehorses before transportation. Immediately after transportation, significant increases in rectal temperature were observed in both treatment groups, whereas the rectal temperature of the IFNα group tended to be lower than that of the control group. Although WBC, Fbg, and SAA immediately after transportation were significantly increased due to transportation in both groups, the extent of the increases in the IFNα group was significantly smaller than in the control group. Long-distance transportation had a relatively profound impact on Thoroughbred racehorses, which was mitigated by IFNα treatment.

2008 American Association of Feline Practitioners' feline retrovirus management guidelines

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are among the most common infectious diseases of cats. Although vaccines are available for both viruses, identification and segregation of infected cats form the cornerstone for preventing new infections. Guidelines in this report have been developed for diagnosis, prevention, treatment, and management of FeLV and FIV infections. All cats should be tested for FeLV and FIV infections at appropriate intervals based on individual risk assessments. This includes testing at the time of acquisition, following exposure to an infected cat or a cat of unknown infection status, prior to vaccination against FeLV or FIV, prior to entering group housing, and when cats become sick. No test is 100% accurate at all times under all conditions; results should be interpreted along with the patient's health and risk factors. Retroviral tests can diagnose only infection, not clinical disease, and cats infected with FeLV or FIV may live for many years. A decision for euthanasia should never be based solely on whether or not the cat is infected. Vaccination against FeLV is highly recommended in kittens. In adult cats, antiretroviral vaccines are considered non-core and should be administered only if a risk assessment indicates they are appropriate. Few large controlled studies have been performed using antiviral or immunomodulating drugs for the treatment of naturally infected cats. More research is needed to identify best practices to improve long-term outcomes following retroviral infections in cats.